Vulvar pruritus—causes, diagnosis and therapeutic approach

Background: In Germany, 17–23% of the population suffers from chronic itching of the skin; in 5–10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women’s quality of life. Methods: This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vulvar pruritus. The search terms were (in German and English) “vulvärer Juckreiz,” “pruritus vulvae,” and “genital itch,” alone and in combination with “Behandlung,” “Therapie,” or “treatment.” Results: The most common cause of vulvar pruritus is vulvovaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essential elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently applied, basic moisturizing care and the avoidance of potential triggering factors. Conclusion: As vulvar pruritus has multiple causes, standardization of its diagnostic evaluation and treatment would be desirable, both to achieve optimal efficacy and to meet the diverse needs of women who suffer from this condition.